Current status of Crimean‐Congo hemorrhagic fever outbreaks in Uganda and other African countries

Following the efforts of Ugandan government to battle the outbreak of Ebolavirus disease in September 2022, there is an outbreak of another zoonotic disease called Crimean‐Congo hemorrhagic fever (CCHF). CCHF causes widespread epidemics in some regions where tick vector is primarily found. Recent outbreaks in Uganda have been documented, and it is believed that this is due to the quiet spread of the pathogen from animals and ticks to people. The aim of this write‐ up is to discuss the current and past outbreaks of CCHF in Uganda and Other African countries and provide necessary recommendations needed to prevent future outbreaks.

Since 2010, Uganda has used a viral hemorrhagic fever surveillance system, where more than 20 sentinel surveillance stations are part of the program and samples from throughout Uganda as well as nearby nations are transported there for examination. 8 In subsequent years, additional confirmation of outbreaks defined as one or more cases has been made because of the expanded surveillance. 9 Based on a seroprevalence study conducted in 2020 in Uganda, it was determined that anti-CCHF antibodies are present and very prevalent in cattle. 8 The infection is linked to a geographical region, growing older, F I G U R E 1 Distribution of Crimean-Congo Hemorrhagic Fever Cases in Africa from 1956 to 2020.
being female, and having a greater tick burden. 10 In research conducted in 2015, a case of human CCHF was diagnosed, which also confirms the endemicity of the virus in Uganda and demonstrates that tick exposure significantly increases the risk of human infection. 11 Other African countries, such as South Africa, Egypt, Senegal, Mauritania, Kenya, Sudan, Madagascar, Nigeria, Niger, Ghana, etc., had recorded sporadic outbreaks of CCHF (Table 1).
This makes CCHF endemic in Africa, which need surgent interventions.
Animals are affected by CCHF, although they do not exhibit any clinical symptoms. However, 20% of people infected develop clinically fatal conditions. 23 It is not unexpected that the fatality rate has been estimated to be as high as 60% in certain regions, making it an infection that has to be reported in many nations. CCHF's global economic impact has not been mentioned in any published reports, but other hemorrhagic fevers that are closely related to it are said to have enormous direct and indirect economic costs. CCHF has the potential to cause a pandemic due to its zoonotic nature, however, the disease is endemic in African countries ( Figure 1).

| CHALLENGES TO BE ADDRESSED IN UGANDA AND OTHER AFRICAN NATIONS
The Several infectious diseases of zoonotic origin have the characteristics of viral hemorrhagic fever, so due to the healthcare system in most African countries, these forms of infections such as Ebola, and arboviral infections were misdiagnosed. Another challenge is vaccine availability, some vaccines are available, but vaccine equity and hesitancy are major challenges. Home slaughter is a factor that may increase the risk of a CCHF outbreak, individuals who slaughter animals at home exposed themselves to the risk of being infected when they meet the body fluids of infected animals.

| RECOMMENDATION AND CONCLUSIONS
One of the important tools in fighting this infection is surveillance, despite the timely surveillance system in Uganda, there is a need to put more effort into increasing the surveillance system, not only in Uganda but all over the endemic regions especially African nations, because determining the origin of an outbreak usually made it easy to tackle an outbreak. So also, healthcare workers should be trained on how to handle infected individuals to avoid transmission of the disease in healthcare settings, and they should also be provided with personal protective equipment.

CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT
Data available on request from the authors.

TRANSPARENCY STATEMENT
The lead author Ridwan Olamilekan Adesola affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.